Prescrire Int. 2014 May;23(149):117-20.
Treatment of obesity and overweight is based primarily on dietary measures and physical exercise.There are still no drugs with a favourable harm-benefit balance in this setting. Lorcaserin, a "selective" 5HT2C serotonin receptor agonist, has been refused marketing authorisation in the European Union despite approval in the United States. Clinical evaluation of lorcaserin is based on three placebo-controlled trials, each lasting one year, in a total of about 6000 patients. Two trials involved obese patients, and one obese patients with type 2 diabetes. The results of these trials are undermined by the large proportion (40% to 50%) of patients who were lost to follow-up before the end of the trial. None of the trials examined the impact of lorcaserin on the clinical complications of obesity. From an average initial weight of about 100 kg, patients taking lorcaserin lost only about 3 kg more than those in the placebo groups.The patients put on weight again after lorcaserin was discontinued. Adverse effects observed in clinical trials were mainly gastrointestinal (dry mouth, nausea) and neuropsychiatric (dizziness, fatigue, headache, euphoria). The incidence of cardiac valve disorders was higher with lorcaserin than with placebo. These trials were too short in duration to exclude a risk of cancer (breast cancer and astrocytoma) that was reported in experimental animals. This serotonin agonist is metabolised by the liver, creating a risk of multiple drug interactions. In practice, lorcaserin has not been shown to prevent complications of obesity or even lead to substantial weight loss.There is therefore no justification for exposing patients to the risk of adverse effects.
肥胖和超重的治疗主要基于饮食措施和体育锻炼。在这种情况下，仍然没有危害效益比良好的药物。洛卡塞林是一种“选择性”5-羟色胺2C（5HT2C）受体激动剂，尽管在美国已获批准，但在欧盟仍未获得上市许可。洛卡塞林的临床评估基于三项安慰剂对照试验，每项试验持续一年，总共约6000名患者。两项试验涉及肥胖患者，一项涉及肥胖的2型糖尿病患者。这些试验的结果受到很大比例（40%至50%）的患者在试验结束前失访的影响。没有一项试验研究洛卡塞林对肥胖临床并发症的影响。服用洛卡塞林的患者平均初始体重约为100公斤，仅比安慰剂组的患者多减轻约3公斤。停用洛卡塞林后，患者体重又增加了。临床试验中观察到的不良反应主要是胃肠道反应（口干、恶心）和神经精神反应（头晕、疲劳、头痛、欣快感）。服用洛卡塞林的患者心脏瓣膜疾病的发生率高于服用安慰剂的患者。这些试验持续时间过短，无法排除实验动物中报告的癌症（乳腺癌和星形细胞瘤）风险。这种5-羟色胺激动剂由肝脏代谢，存在多种药物相互作用的风险。实际上，洛卡塞林并未显示出能预防肥胖并发症，甚至也未导致显著体重减轻。因此，没有理由让患者承受不良反应的风险。
